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Home My WebLink AboutMiscellaneous Application 2007-8-7 r ~1 ~1 ~ ." .v-:11 ~~ ~ ~ ."'.r-11 y---14 r)~ 0--1 ~1 ~.~ .~~ ~4 ~1 ~ ." . r;:11 ~~ ~ ~ f~ ...-:-- 1 ~} C:J lr-11 ~ ~4 ~ ~} ~1 ~4 lr--I~ ~ ~ ~ e>) ~~ ~ ~Q ~ ~.;: ~ . . SPRINGFIELD CITY OF SPRINGFIELD, OREGON ., SCAN~ED 225 fIITH STREET. SPRINGfIELD, OR 97477. PH:(541)726-3753 . FAX: (541)726-3689 City Job Number (..Or/\A 'Z.c:> 0 7 - i::, II b S- Job Location: 5~3-S- ~~r { ~ 1- ~\)Q c:..Q , Assessor's Map: I 7 0 Z. :51 C> 0 .\ \"') \ Tax Lot: 0(300 Owner: _M I). c\<... ~ (' h~\~~~f'-<..Q....(\ Address: -5 ~ ~g- ~t"'A. ~ SL { .s;- "",?a.. LJL \ t:) I City: ~ ~&=t-(> \n State: ----C"'R. Phone: ~/I- 3' 4S'- ^, J~ Zip: C4tLJl~ Preliminary Inspection for wood burning inserts is $61.50 (prior to insert). Wood Stove/Pellet/Insert Permit is $71.50 (includes applicable fees and surcharges). ~ Contractor Informatio~ ~~'^ -1/. ~ ~~ ~ v;-~_ ,o^ ~. ~u '~,~ . 41J- ~h ~d~one: State: {90 ~~~ ~ &'~ Zip: <?..d, <::> l" ~~~s: 'r ~1'~ ,;s> ~~ ~<? ~ ~J~ 4c' By signing this permit/application, I agree to call for an inspection(s) as'~~~-3769). I state that all information on this application/permit is correct and that I.w~~(!~th the Wood Stove Safety information for wood burning iances and prelimina~~~ standards as set by the Oregon Department of Envi~ e I Quality or the Fede~ V~ Environmental Protection Agency and I agree t . ting approval number to the inspector at the time of inspection. I also under . requesting a preliminary inspection, the wall covering may be requir~~~~ Jt~~V ~ 01R ~d ~ ~ ~ 19~ 90 ~o... 19,. ~9 ~~ 7Y.1... ~ ~()'-'71.l: a ~ d. ~ .-0' ^ d c,1J. ?./ _ ~ 19~ ~~"~ qs~o r'2~~~ "c5h.,../ Signature: ~~)~~4.190.9r. _~,,~~: .'(9n3i./"I /J>\ 7 ~ -e' '~'''k'~-~ ~ 'CSl~ r- ,- - - - 'm____ - ~ ,- FOR'omCEUSE ~lS'QO~~1:4'Z~~~~~~' I , " u____, -- - - -, __-u_n_~~;~~4)-~t~-Q ~ -- ---- 0--/7 ~~'7 ~.O~~~~4'~~~ Date of Application: 0 , ,/&-- io'-: "'W. -'7.... v... I ' 0;0.....- - V"" Checked for Historical Sta~~ Contractor: ([)lA)'\\~\ Address: City: Construction Contractor's Registration #: Checked for Delinquencies: I./' Shared Drive(T:)lBuilding Fonns/Wood Stove PenniI7-07.doc GmUNG~i' -- ":' ',/"" ....."><, ,';"'<I>,{~~:";:~,:,;";;,:,:"",<,,"".J;;:~,,,",,,:,;tf f ~ .' . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01165 ISSUED: 08/07/2007 APPLIED: 08/07/2007 EXPIRES: 02/07/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5335 Daisy St 101 ASSESSOR'S PARCEL NO.: 1702330001300 Springfield TYPE OF WORK: Wood Stove TYPE OF USE: New Residential PROJECT DESCRIPTION: Wood stove Owner: MARK GREEN Address: 5335 DAISY ST #101 SPRINGFIELD OR 97478 Phone Number: 541-345-0717 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor OWNER License ExpJration Date Phone BUILDING INFORMATION I VB # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: . Energy Path: Sprinkled Building: n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 . I DEVELOPMENT INFORMATION I .' \f \\-\~ \f;JORl\ Frontyard Setback: ~o,~ti.~ \-\"U. ~?\~~~~~~wr~&\Ol Side 1 Setback: u\S ?t.~W\\\ S ~Ot.R ,\,\\S ~}r~<< ~s Rqd: Side 2 Setback: 'f' O~\lt.O U "'3~~1Dh\\ltt'brive Rqd: . Rearyard Setback: ~U'\'\\\I\t.~Ct.O O~ \SOo % of Lot Coverage: Solar Setbacks: COWh'41 n ('\~'l ?t.~\ · . . . HV '\ ~u \I "U\ . I PUBLIC IMPROVEMENTS I AI IClfWeW!lbWff6it law requires you to follow OOMl~etnXh!ft&be Oregon Utility Notification Center. Those rules are set forth In OAR 952-Q01-Q010through OAR 952-001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone .......i.... 'v. ~llg .JII:IYUIl ullmy NuunOBUon I Valuation Description I Center Is 1-800-332-2344). ' REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction $ Per Sq Ft or multiplier. Square Footage or Bid Amount Value Date Calculated Paee 1 of 2 -~~!n~~~!itt~\",c _ ''','I;, " ~~; ~. ~';': j;"\ ~~ 'ji., Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 hispection Line Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Minimum/Adjustment Mechanical Wood Stove/Insert Total Amount Paid . Amount Paid $20.00 $5.00 $2.50 $4.00 $17.00 $33.00 ' $81.50 Total Value of Project Fees Pai,d I Date Paid 8/7/07 8/7/07 8/7/07 8/7/07 8/7/07 8/7/07 I Plan Reviews I . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01165 ISSUED: . 08/07/2007 APPLIED: 08/07/2007 EXPIRES: 02/07/2008 VALUE: Receipt Number 2200700000000001262 2200700000000001262 2200700000000001262 2200700000000001262 2200700000000001262 2200700000000001262 To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Wood Stove: After Installation. I ~e<wiled IlW>ectious J By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is' true and correct, and 1 further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein,and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.' I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, .and the approved set of plans will remain on the site at all times during construction. ~~ Owner or contra~tor~re Paee 2 of2 0/7 II) 7 Date . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us , . , . , . Permit #: L ())//"...., 107- c:> JIb S- Address: 5335-" ~Al~V '\..If'? f Issued by: ~ 'Jj Date: ~-.- 10 I ?'/7/0/ I I Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~ 1::::1 1. )Lr" 2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. o 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR ~. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to. Property Owners about Construction Responsibilities on the reverse side ofthis form. ~~~ --- 8-/}/07 (Sign~--tPermit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 A -, 0" ". ,- -0" ... tr< ~ tr< · '" \. Clln.g 'as 1L .our\ fWD u~n.~rai \L.ontractor [ -~ iNfFOfRMAT~ON NOTICE TO PfROPlEfRTY OWNIER~ ABOUT. CONSTIFUJCT~ON I RrESPONS~B~UT~IES .9, ','t . t. J , .= -. - _.__....._...-_______~___.. .~__________ ",__ - _n. __,,_"___ I : NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the I ,_~onstru~ti~n con~~~~~~~_Bo~n:~n a~:~rdance with ~~~!01.0~~(5), ~:~S~d byt~~~_9~9?regOn Legislature. ] If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. lEmmjpll((])yerr JRe~jp((])IIll~nbnnntne~ You will,. in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As ttlln.e eIDjpHoyeJl', YOM mmis~ cOIDjpHy wWln ~lln.e lfoHllownung: Oregoun's Wi~nnnnoH(JJnung 'Fu .IL2lw: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988.' UlID.emjpHoymelID~ .lIlIDSMJl'alIDCe 'F2lJ,(: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. . The Oregon Business Identification Number (BIN) is a combined number for. both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or wVi'w.dor.state.or.us/formsoav.htmll for the appropriate forms. Workers' CompelID.s2l~uolID. JIunsMIl"2llIDce: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S. .lIlID.lteJl'lID.aH Revemlle SeJl'Vnce: As an employer, you must withhold federal income tax from employees' wages., You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the' IRS at 1-800-829-4933 or visit their web site at www.irs.f!ov. . . (Q)~nneJr lR.e~]p)((])Inmfi1l:>>fillfi~fie~ tillIIll<<ll Arretal~ ((])[ CC((])nn~errIffi~ Co(JJe COIDpHn2llID.te: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. lLll2llhmry 2llrll(JJ Property Dam2lge ][I!llSMr2llID.Ce: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. { " _ ' " .,,-\.\. ".. .... ~ 'Fume: Make sure you have sufficient time to supervise your employees. JEJ,(!peJl'ltu!;c: Make sure you have the skills to act as your OW1.{ general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ owner. doc 06-01-04 . 225 F.ifth .Street 01 ,.. Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-01165 COM2007-01165 COM2007-01165 COM2007-01165 COM2007-01165 COM2007-01165 Payments: , Type of Payment Check cReceintl RECEIPT #: . of Springfield Official Receipt velopment Services Department Public Works Department 2200700000000001262 2:29:48PM Date: 08/07/2007 Description , Wood Stove/Insert Minimum! Adjustment Mechanical -Mechanical Issuance Fee- + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By MARK GREEN Amount Due 33.00 17.00 20.00 2.50 4.00 5.00 $81.50 Item Total: Check Number Authorization Received By Batch Number Number. How Received djb 589 In Person Payment Total: Amount Paid $81.50 $81.50 Page I of I 8/7/2007